A 16-year-old boy presents with wrist pain after falling off a bicycle. The exam and X-ray suggest a displaced fracture near the wrist. What is the most appropriate next step?

• A. Transfer to the emergency department for immediate orthopedic evaluation
• B. Apply a short arm cast and discharge home
• C. Splint and arrange outpatient follow-up
• D. Provide analgesia and discharge with instructions

Answer: (A)

When a teenager sustains a displaced fracture near the wrist, the priority is urgent orthopedic assessment to restore and maintain proper alignment. Displacement means the fracture is unstable and may not heal correctly if left alone, increasing risks of malunion, stiffness, and impaired wrist function. Immediate orthopedic involvement in the ED allows for timely reduction (often with analgesia or sedation) and definitive stabilization, which is essential to optimize outcome.

In the meantime, provide pain relief and assess distal neurovascular status, but do not rely on just splinting or discharge without ortho input. Discharging with a simple cast or sending home with instructions is inadequate for a displaced intra-articular or metaphyseal fracture near the wrist, and outpatient follow-up without urgent evaluation could miss the need for reduction or surgical planning.